title: Factors associated with not using folic acid supplements preconceptionally.
abstract: OBJECTIVE
  Neural tube defects are among the most common birth defects worldwide. Folic acid intake from one month before to three months after conception reduces the likelihood of neural tube defects by at least 50%. Since 1995, several campaigns have been organised in the Netherlands which resulted in 51% of pregnant women using folic acid supplements during the entire recommended period in the northern part of the Netherlands in 2005. Our research question was to gain insight into the current prevalence and factors associated with inadequate pregnancy-related use of folic acid supplements.
  
  
  METHODS
  Data from the DELIVER study were used, which is a population-based cohort study.
  
  
  METHODS
  Twenty midwifery practices across the Netherlands in 2009 and 2010.
  
  
  METHODS
  In total 5975 pregnant women completed a questionnaire covering items on sociodemographic and lifestyle factors, including folic acid intake.
  
  
  RESULTS
  Of our study population, 55·5% (3318/5975) used folic acid supplements before conception. Several sociodemographic and lifestyle factors were associated with no preconception use of folic acid, of which non-Western ethnicity and not having a partner had the largest effect size.
  
  
  CONCLUSIONS
  In the Netherlands, the folic acid intake before conception is suboptimal and has not improved over recent years. Fortification of staple foods with folic acid should be reconsidered as it would provide a more effective means of ensuring an adequate intake, especially for those groups of women who are unlikely to plan their pregnancies or to receive or respond to health promotion messages.
authors.affiliation: 1Department of Midwifery Science,AVAG and the EMGO Institute for Health and Care Research,VU University Medical Center,Van der Boechorststraat 7 (MF-D4.44),1081 BT Amsterdam,The Netherlands.
authors.forename: Judith
authors.initials: J
authors.lastname: Manniën
authors.affiliation: 1Department of Midwifery Science,AVAG and the EMGO Institute for Health and Care Research,VU University Medical Center,Van der Boechorststraat 7 (MF-D4.44),1081 BT Amsterdam,The Netherlands.
authors.forename: Ank
authors.initials: A
authors.lastname: de Jonge
authors.affiliation: 2Clinical Genetics and EMGO Institute for Health and Care Research,VU University Medical Center,Amsterdam,The Netherlands.
authors.forename: Martina C
authors.initials: MC
authors.lastname: Cornel
authors.affiliation: 1Department of Midwifery Science,AVAG and the EMGO Institute for Health and Care Research,VU University Medical Center,Van der Boechorststraat 7 (MF-D4.44),1081 BT Amsterdam,The Netherlands.
authors.forename: Evelien
authors.initials: E
authors.lastname: Spelten
authors.affiliation: 1Department of Midwifery Science,AVAG and the EMGO Institute for Health and Care Research,VU University Medical Center,Van der Boechorststraat 7 (MF-D4.44),1081 BT Amsterdam,The Netherlands.
authors.forename: Eileen K
authors.initials: EK
authors.lastname: Hutton
mesh_terms: D000328:Adult; D000349:Africa / Q000208:ethnology; D001208:Asia / Q000208:ethnology; D015331:Cohort Studies; D019587:Dietary Supplements; D005260:Female; D005492:Folic Acid / Q000627:therapeutic use*; D006801:Humans; D007843:Latin America / Q000208:ethnology; D008019:Life Style / Q000208:ethnology; D039382:Maternal Nutritional Physiological Phenomena / Q000208:ethnology; D008880:Midwifery; D009426:Netherlands; D009436:Neural Tube Defects / Q000208:ethnology / Q000517:prevention & control*; D018673:Nutrition Policy; D010349:Patient Compliance / Q000208:ethnology; D016742:Preconception Care; D011247:Pregnancy; D011446:Prospective Studies; D012847:Single Person; D014421:Turkey / Q000208:ethnology; D055815:Young Adult
chemical_list: D005492:Folic Acid